Provider Demographics
NPI:1164083739
Name:PATEL, DUSHYANT NATVARLAL
Entity Type:Individual
Prefix:DR
First Name:DUSHYANT
Middle Name:NATVARLAL
Last Name:PATEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 MAYFAIR LN
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:IL
Mailing Address - Zip Code:62881-4272
Mailing Address - Country:US
Mailing Address - Phone:618-204-7858
Mailing Address - Fax:
Practice Address - Street 1:1 WESTBURY DR
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63301-2550
Practice Address - Country:US
Practice Address - Phone:636-723-6071
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-25
Last Update Date:2019-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO201902231351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice